Posttraumatic scarring in various parts of the body poses a common and challenging problem for plastic surgeons. When evaluating treatment options for scar deformities, both functional and aesthetic aspects are considered in order to develop the most effective treatment plan. A wide range of surgical and non-surgical approaches have been documented for the treatment of scars. Surgical techniques such as simple excision, Z-plasty, and W-plasty have been found to effectively address the root cause of scarring, thereby increasing patient satisfaction [1]. However, postoperative scarring can become a new challenge if the initial scar is wide or long. Non-surgical options such as laser treatments are commonly employed for scar treatment, but their efficacy may be suboptimal, especially in cases of depressed scars where satisfactory outcomes may not be achieved through revision alone [2]. Although fat injection can be performed to correct the contour of a scar [3], it may not produce desirable results if performed alone due to uneven distribution and rapid fat tissue absorption [4]. It may also require release and dissection of the contracted scar tissue. This study presents a new correction method that utilizes a cutting wire and autologous fat grafting, which yielded satisfactory results in correcting a wide, depressed scar.

The patient, a 34-year-old female, presented with a 6 × 3-cm scar on her left hip. The scar was caused by blunt trauma when the patient slipped 7 months earlier, resulting in a closed wound. The shape of the scar was a depressed oval, which blended in color with the surrounding outer skin. Furthermore, the scar was affixed to the surface and did not move in relation to gluteus muscle motion.

Scarring resulting from abnormal collagen production can lead to irregular scars on the surface and result in depressions [5]. Over the years, several techniques have been introduced to correct wound depressions by resolving adhesions in the underlying deep tissue. Inchingolo et al. [6] introduced a method to correct scar depression by making a U-shaped suture after direct dissection of the adhesion with a surgical scissor. A new technique called dermal tunneling was proposed by Lima [7] to treat scar depression by loosening the fibrotic tissue in the dermal layer, but it was only reproducible in the transepidermal depth. In addition, Graivier [8] reported treatment methods using diamond wire, SurgiWire, and wire scalpel, in which the dissection was performed through an insertion made into the subcutaneous tissue below the dermal-subcutaneous junction [8]. However, these methods have limitations, particularly in patients with deep depressions that are difficult to resolve with subcutaneous tissue dissection.

In this study, the movement of the buttock scar was fixed to the motion of the gluteus muscle, which corresponded to sparing of the muscle layer [9]. However, a deep and wide scar could be inferred by the involvement of the fat tissue below. Therefore, we restored the contour of the tissue by separating the boundary between the scar tissue and the normal tissue below to secure space for the fat graft.

Although buttock scars are usually covered by clothes and may be considered less important aesthetically, we could not ignore the aesthetic outcome of the revised scar in this case because the patient worked as a model. Our surgical methods increased the patient’s satisfaction by only leaving a tiny incisional scar where the wire passed without leaving a visible linear postoperative scar. We were also able to restore the contour of the deformity by using the fat graft as tissue padding to correct the depression of the scar. Furthermore, the cutting wire used for this case was Ethicon No. 5 stainless steel wire (Ethicon, J&J Surgical Technologie), which is generally used in hernia repair and bone wiring [10]. Since surgical steel wires are stiff, resilient, and inexpensive, this procedure is easily accessible and reproducible [11].

During the procedure, we made a wide enough bite when tagging and holding the central portion of the scar with a 4-0 nylon suture to prevent thinning of the skin. We also ensured that the cutting plane was parallel to the scar by carefully controlling the wire during the incision. By taking a wide enough bite, the suture was able to hold the entire scar tissue without putting excessive tension on any one area, which helped prevent thinning of the skin. In addition, by controlling the wire and ensuring that the cutting plane was parallel to the scar, the surgeon could minimize the risk of damaging surrounding tissues and structures.

The wire was penetrated into the junction just below the scar tissue and not directly into it to minimize direct bleeding during the procedure. To prevent the possibility of unseen internal bleeding due to the small openings, periodic compressive hemostasis was also performed.

There were a few limitations in this case other than the complexity of the procedure. First, since the cutting wire was used to perform a closed blind dissection, the targeted layer could only be inferred by the resistance of the dissection plane, without direct visual confirmation. Second, the evaluation and confirmation of postoperative results relied solely on visual measurements and patient satisfaction. Finally, the fat tissue that was injected demonstrated notable longevity, which can be attributed to the non-involvement of the muscular layer. This is supported by the absence of skin dimpling during muscle contracture [9]. Using the hip region as the injection site was also advantageous, as it already possessed a high concentration of fat tissue and was less susceptible to movement-related disruption, thus aiding in the maintenance of the injected fat tissue. Other areas of the body may have different tissue characteristics and respond differently to the surgical technique. Therefore, while the technique may hold promise for scar revision in other areas of the body, additional research and clinical trials are needed to determine its potential effectiveness and safety in other areas.

Nevertheless, we report this surgical method as a simple and effective procedure that can resolve depressed contour deformities, leaving a minimal scar.